First Name*

Last Name*

Address

City

State/Province

Zip/Postal Code
 - 

Email*

Home Phone

Cell Phone*

Alt Email

Which animal would you like to adopt?
Choose an animal: Asher Bayou Beatrice Betty Bo Boots Brantley Chyna Cleo Cujo Lee Dani Domino Dot Fernando Fitzgerald Fleur Francesca Hera Jeff Knee Megan Merica Mutt Otis Patricia (P pups) Penny (P pups) Priscilla Rose Rosie Scar Sonny Yeller

If adopting a cat, please type it’s current name.

May we check a vet reference?*
Choose one: yes no

Vet name and phone number*

Please tell us what a day in the life of your adopted pet would like like. How long will they be alone on a typical day, will they stay inside or outside, children and ages of children, ect?

Do you agree to keep vaccinations current and to keep the pet on worm and parasite prevention?*
Choose one: yes no

When taking the pet outdoors, will it will be wearing proper ID, be on a leash, or in a fenced area?*
Choose one: yes no

Do you agree to care for the pet in a humane manner and be a responsible pet owner by spaying/neutering the animal if not already done?*
Choose one: yes no

Do you agree to provide your dog with a fenced in area to exercise or to take them on multiple daily walks?*
Choose one: Yes No NA (Cat adoption)

Do you agree to provide adequate food, shelter, attention, and veterinary care to the animal you are adopting?*
Choose one: yes no

Do you understand that the cost to care for a healthy pet is at least $700 per year?*
Choose one: yes no

Do you agree to release UHS for any and all claims in the event that the cat adopted is FIV or feline leukemia positive or the dog adopted is heart worm positive? *All our dogs will have a heart worm status at time of adoption and be on heart worm prevention.*
Choose one: yes no

Do you understand that UHS does not guarantee the good health of the animals being adopted? They have all been vetted, are up to date on vaccines, on flea and tick prevention, on heart worm prevention, and have been spayed/neutered if of age. However, this does not guarantee the complete health of any animal. *
Choose one: yes no

Do you understand that UHS does not guarantee the good behavior of any animal being adopted? Most animals being adopted through UHS have been strays preventing UHS from knowing all previous medical or behavioral history. Do you release UHS from any liability should any medical or behavioral problems arise after the adoption of the animal. *Please note that UHS would never allow an animal to be adopted that is known to be aggressive. *
Choose one: yes no

Are you adopting this dog for yourself?*
Choose one: yes no